Sexual Identity Therapy Framework to Be Reviewed

I posted this to the SIT Blog and I hope other bloggers post this on their blogs.

News Release

Sexual Identity Therapy Framework to Be Reviewed

The Sexual Identity Therapy Framework, authored by Warren Throckmorton and Mark Yarhouse, will be reviewed in 2008 for possible revision. Proposed as a means to help counselors work with clients who experience value conflict surrounding homosexual attractions, the Framework is endorsed by Nicholas Cummings, the father of managed behavioral healthcare and Robert Spitzer, the architect of modern psychiatric diagnosis. The framework respects diversity of sexual orientation and religious practice and anticipates a planned review of sexual orientation counseling which will be reported by the American Psychological Association in 2008.

“We believe this area of counseling practice is changing rapidly and we want to be sensitive to how therapists and consumers of sexual identity therapy feel the framework helps or hinder excellent outcomes. We want to hear from professionals and consumers alike,” said Dr. Throckmorton.

The authors are asking for public and professional comment on the Framework though the end of February, 2008.

I have reviewed the sexual identity framework written by Warren Throckmorton and Mark Yarhouse. This framework provides a very necessary outline to help therapists address the important concerns of clients who are in conflict over their homosexual attractions. The work of Drs. Throckmorton and Yarhouse transcend polarized debates about whether gays can change their sexual orientation. Rather, this framework helps therapists work with clients to craft solutions tailored to their individual situations and personal beliefs and values. I support this framework and hope it is widely implemented.

Robert L. Spitzer, M.D., is Professor of Psychiatry, Columbia University, New York State Psychiatric Institute, New York City, NY. Dr. Spitzer was Chairman of the committee that developed the Diagnostic and Statistical Manual of Mental and Emotional Disorders, 3rd Edition and 3rd Edition (Revised).

Drs. Throckmorton and Yarhouse have brilliantly resolved contention in psychotherapy by providing the field with unbiased guidelines that are responsive to scientific evidence, are sensitive to professional practice, and which restore patient determination in choosing his/her goals in psychotherapy.

Dr. Nicholas Cummings, PhD, ScD is Distinguished Chair in Psychology, University of Nevada, Reno. Dr. Cummings is the President of the Foundation for Behavioral Health and Chairman of the Nicholas & Dorothy Cummings Foundation, Inc. He was the founding CEO of American Biodyne (now Magellan Behavioral Care). He is also the former President of the American Psychological Association. Dr. Cummings was the founder of the four campuses of the California School of Professional Psychology, the National Academies of Practice, and the American Managed Behavioral Healthcare Association. He was the former Executive Director of the Mental Research Institute. Dr. Cummings is the co-editor with Rogers Wright of Destructive Trends in Mental Health.

One point I am considering is to discourage referral to NWTA and I-groups as a means of changing orientation. While no outcome studies have been done on this point, it seems clear that such referrals do nothing on average to change orientation. We welcome feedback and suggestions.

I’m sure we’ve talked about this before, but I do not remember your responses. Given that there are many different kinds of “conflicts” that can surround one’s orientation, how do you separate out those that are being influenced from the outside: by society or its institutions (including religion), from what the person “values” on the inside? I’m assuming this would need to be figured out first before you could go on with the counseling.

I differ a little from Dr. Spitzer. This isn’t just about rising above the debate about changing orientation, this is about treating homosexuality as if it is a disease, when it is not – at least not by any standard that we use to define other diseases. Does SIT address this?

I’ve glanced at the SIT framework, and I think there’s some good in it – and I’m sure it will be modified as time goes on.

I’m curious to get your take on the items I listed above Warren. I’m also curious about how you are going to deal with children/teenagers who do not want counseling but are forced into it by their parents. This might not be a frequent occurrence, but growing up in a conservative town and family like I did, I’m sure that situation will crop up.

Its been awhile so I’ll re-read the framework, but please do share your thoughts with me when you have time.

Drowssap

jayhuck

Just to play devil’s advocate.

Could you not make the case that peope with exclusive and lifelong SSA have a disorder of the reproductive system?

The brain is often called the largest sexual organ in the body. Being exclusively attracted to sex partners who can’t produce offspring could be considered a disorder, particularly if it is unwanted.

ken

Drowssap asked in post 79837:

Could you not make the case that peope with exclusive and lifelong SSA have a disorder of the reproductive system?

Only if you consider anyone who engages in sexual activity for purposes other than reproduction to have a “disorder of the reproductive system.”

http://www.patheos.com/blogs/warrenthrockmorton/ Warren

jayhuck – I will reserve addressing those issues until you read the framework since your questions are addressed by it.

Eddy

Warren–

This one sentence probably sums up why I’m behind you all the way on SIT. “Drs. Throckmorton and Yarhouse have brilliantly resolved contention in psychotherapy by providing the field with unbiased guidelines that are responsive to scientific evidence, are sensitive to professional practice, and which restore patient determination in choosing his/her goals in psychotherapy.” I’m sure some will dicker over the word ‘brilliantly’ but otherwise I think you’re providing the psychological community at large with a tool that will enhance both their understanding and their therapy.

I think the culture warriors will try to spin your words, your motives, etc. but I believe you and Mark are up to that challenge.

http://www.patheos.com/blogs/warrenthrockmorton/ Warren

Thanks Eddy. I appreciate your support. This will be an eventful year for the framework and for standard setting in the professions on this issue. I can’t reveal all the goods but some cool stuff is in the works…

http://www.myspace.com/jayhuck2point0 jayhuck

Warren,

I’m actually enjoying the framework a second time through. I still have questions about adolescents though. The framework says:

Parents may bring in teens who are unable to provide legal consent. The role of

the therapist here is to take a consultative role. Therapists can point parents and younger

teens to research showing that uncertainty and/or confusion concerning sexual identity is

not uncommon and that there should be no rush to declare a sexual identity at a young

communicate that an appropriate parental stance is to provide consultation and support

for their child and to refrain from shaming children for openly expressing their distress to

parents and the therapist. In cases where parents and children are at odds due to sexuality

conflicts, clinicians should seek to reduce family conflict and preserve a safe place for

both parents and children to work out their relationship.

I would assume the therapist would also let the parents know things we’ve talked about before: such as, homosexuality is not a disease and there is nothing wrong with developing a gay identity, right? I mean, if the only message to be given is one of understanding the confusion that can surround sexual identity, that same message should be given to kids who might identify as straight – Yes? No?

Ann

Jayhuck,

Do you really think children can identify as who they are going to be for the rest of their lives? Do they have the ability to identify themselves as anything other than children with feelings? They have a lot of living to do before any kind of identification can be rendered and accepted.

http://www.myspace.com/jayhuck2point0 jayhuck

Ann,

What do you mean by “children”? Are we talking about adolescents or people younger than this group? I agree that alot of living has to be done by some, but I still believe that many adolescents know who they are primarily attracted to.

http://www.boxturtlebulletin.com Timothy Kincaid

Do you really think children can identify as who they are going to be for the rest of their lives?

Yes.

The vast majority of gay persons will tell you that they were aware of the direction of their physical, emotion, and romantic attractions at a young age.

http://www.patheos.com/blogs/warrenthrockmorton/ Warren

jayhuck – The same information we discuss under the informed consent aspect of the framework is given to parents. So they are informed that homosexual attractions per se are not considered a mental illness, etc.

Timothy – I do not think that telling a kid who is confused that he is gay will make him gay, but it does violate the spirit of our framework and seems out of sync with what we know about identity development. About a quarter of kids may manifest some confusion about their sexual identity as middle school students and those who have SSA should not be told at that age that they are gay. An assessment of history, duration, etc., should be conducted but for many kids, they are still forming their attitudes and so we recommend this more cautious stance. I am sure you agree that not all kids who experience SSA in high school are gay. I know well-meaning therapists who have told kids like that who are probably bisexual or simply influenced by contextual factors, that they are gay. This sets off a whole series of disruptions in family, school, self, etc.

ken

Warren said in post 80039:

I am sure you agree that not all kids who experience SSA in high school are gay. I know well-meaning therapists who have told kids like that who are probably bisexual or simply influenced by contextual factors, that they are gay. This sets off a whole series of disruptions in family, school, self, etc.

I’m curious Warren, do you also worry about therapists who tell kids who are gay that they are “just confused and aren’t really gay”?

http://www.patheos.com/blogs/warrenthrockmorton/ Warren

Yes, I was addressing Timothy specifically, but that situation is also why we recommend caution.

jayhuck

Warren,

If an adolescent is primarily attracted to the same sex, would you encourage them to refrain from adopting an “identity”, even if they know this? I’m just curious.

And when it comes to discouraging some confused kids from adopting an identity, would you also encourage kids who feel they might be straight from adopting such an “identity”?

http://www.boxturtlebulletin.com Timothy Kincaid

Warren,

I am perplexed at the notion that some kid has to be “told he is gay”. It suggests that he’s blythely trotting along the path of life and some outsider interferes and pushes some identity on him. That is, to the best of my knowledge, never the case.

If there is a clear definition of sexual orientation – i.e. those who are always or primarily same-sex attracted – then this theoretical kid will know on his own, though it may take him some time to get there. The only time someone has to “tell him” is when the waters have been muddied by those who do not want a clear definition provided.

http://www.wthrockmorton.com Warren

In my experience, I know of situations where confused kids who do not know what they feel have been told this. I hear of it about once a month from various sources. I have verified enough of them to believe it happens, although I do not know how often.

jayhuck – if ever I have a kid with no SSA who wonders if he/she is straight, I would do what I would do with an SSA kid who is not sure of his direction.

http://www.myspace.com/jayhuck2point0 jayhuck

Warren,

I’m sure that does happen. Thanks for letting me know about the SSA kids – I appreciate it.

I’m assuming at this point that if you discover a kid is primarily attracted to the same-sex – and knows this, or it comes out during the counseling session, you are not going to discourage them from accepting their SSAs, right? – unless they themselves, not their parents, have a problem with it? Am I reading you correctly?

Ann

where confused kids who do not know what they feel have been told this.

This happens quite a bit in residential (not home) facilities for foster care children and adolescents.

Mary

Timothy,

Just from experience – I used to tell people that I always felt gay, knew I was different etc….

The truth is – I always felt different. I was always a little more attached to my teachers than my friends were. But it was in later years that I would have euphoric recall about my romantic interests – I guess as a way of justifying myself. Looking back on my growing up years and then later attestments – I was interpretting my youth through a lense that was taught to me by my community and encouraged by my mother – specifically. I truly do not think I romanticised my friendships and teachers etc… But I did still feel different. (Now my interpretations of that are really just for me – however I am clarifying your statment from an ex gay perspective)

http://www.myspace.com/jayhuck2point0 jayhuck

Mary,

I think that does happen, but when I was growing up I would have called myself confused – even though as I looked back on it when I became older, it was very clear which gender I was attracted to. I spent all my time looking at men in magazines as an adolescent. I fantasized about men, etc. Oddly enough, I never really thought of myself as gay until I was further along in my adolscent years – I thought of myself only as different, but I was really gay.

http://www.myspace.com/jayhuck2point0 jayhuck

Mary,

I do appreciate your perspective though. I think sometimes kids who might believe they are confused really aren’t, and kids who might think they are sure about something really aren’t that either.

Mary

Yes, Jayhuck, you are attracted to men and always have been. Thank you for clarifying. I believe you.

http://www.myspace.com/jayhuck2point0 jayhuck

Mary,

My point really wasn’t that I’ve always been attracted to men – even though I have been. My point was how I “felt” about myself when I was growing up.

Mary

I get it. You felt you were always gay, always will be and will never change because that is the way you were born.

http://www.boxturtlebulletin.com Timothy Kincaid

Warren,

I don’t doubt that some kids “have been told they are gay”. And even by adults. Perhaps even adults in positions of authority.

But were they not? Are these kids who did not have same-sex attractions? Are these heterosexuals?

The reason I ask is because you and I probably differ on what “being gay” means. If indeed these kids are solely or primarily attracted to the same sex, then yes, they are homosexual.

If some program gets them to live celibately and identify as something else and struggle the rest of their lives in living a life consistent with their values and not their attractions, some would probably say they are not homosexual. I would still say that they are homosexual. Maybe not “gay” per se, but their orientation is homosexual.

Because I measure off innate responses – sexual, romantic, emotional attraction – not on lifestyle or religiously mandated identity.

If, however, these were experimenting heterosexuals, then they are indeed being provided with inaccurate information.

jag

Mary -

I think what Jayhuck might be trying to say, is that children and teens are at various places in their own knowledge of their sexual identity. I think most of us, in retrospect, can say with more clarity now…than at the time. Some will know a lot more than others.

For myself, I hadn’t really even thought about women as sexual until my late teens (when statistically, most lesbian women have their first same-sex experience). If someone would have asked me when I was 8, or 13.. I likely would have said I was definitely straight….which wouldn’t have been accurate.

I think some people “know” who they are attracted to (men tend to report more consistent attractions than women) when they are quite young…some in adolescents, and some in early adulthood. Either way, it isn’t for me to discount their reported experience of themselves.

I would hope that we are not “telling” people who they are in their sexual identity…but that means, listening to them and allowing them to evolve wherever they might be at. Some will feel themselves to be gay, bisexual, straight, etc..and it isn’t for me to tell them that they are or are not – but I would encourage their personal journey to cognitively explore these things – wherever they might be, and support them.

Mary

I agree with you Jag. I’m just tired of someone else telling me what most people are. There is such variety in sexuality – if anything this blog should have been enough to convince anyone of that. And I get. He’s a homosexual and always has been whether or not he could say the word. That’s HIS experience.

http://www.myspace.com/jayhuck2point0 jayhuck

Thanks for helping me explain myself Jag

Mary

Jag,

Haven’t I been saying that the whole time and yet it is Jayhuck who keeps making the most, all and then misquoting research for his arguments??? Aren’t you and I saying the same thing. It seems to me that Jayhuck is soooooo trying to say something about hmself as justification or something. So I just said it. He is what he says he is.

Now can we agree that people have different experiences?

http://www.myspace.com/jayhuck2point0 jayhuck

Mary,

I wasn’t trying to use research to say anything other than what the research itself says. I agree that people have different experiences and have never believed otherwise.

jag

wow…I’m staying out of this one…

I was just clarifying what I was reading, with a touch of my own perspective. If you both agree with it – fantastic, we’re at a momentous occasion here at the blog!

http://www.sexualidentityinstitute.org Mark

Timothy,

I think one of the challenges in these discussions is that much of what we know about what an adult was like as a child is based upon recall memory (most studies are retrospective). Many people on both sides of these discussions recognize that people who have an identity as an adult interpret their past in ways that correspond with their current identity. We can imagine someone who says they are ex-gay doing that by interpreting certain parent-child relationships in ways that correspond with how they view their current experiences of SSA and corresponding identity. We can also imagine someone who is gay doing that by interpreting feeling different in ways that correspond with how they view their current experiences and identity.

This raises questions for conducting better research in this area, but in the meantime it also raises questions for how to best provide clinical services when a specific person is sorting out these concerns.

Mary

Jayhuck,

As on the other thread to extrapolate from a limited research of two years to be meaningful and relevant to those who have been ex gay longer (and I’m sure there are more ex gays beyond two years than in the two year frame) then you cannot use that to say something about ALL gays. Disagree with me if you want to on this rule but social scientists and statisticians would concur with me.

What you can say accurately is that within a two year period of people who are associated with a ministry group and are in some sort of program for changing their sexuality that 62% are celibate at the time of reporting.

I think Mark nailed the issue for the clinician. Hindsight bias is a relevant consideration in evaluating after the fact what clinicians do. Again, we advise caution because we do not know who is gay and who is not, who is experimenting and who is not as matters of fact in current time.

Most of the kids I work with experience patterns of attraction that are ambiguous to them (they went through a gay period and they are not now attracted to the same-sex or they are now in a gay period after an early teen period of only opposite sex attraction). Believe it or not, there are people who do not go through normative stages a through z on their way to a gay or straight identity.

If it makes it clearer, if a kid said I am attracted to the same-sex and I have always been attracted to the same-sex with no opposite sex attraction, I would label such a kid confused or in some stage.

Mary

Warren and Mark,

I agree. And it is with caution that the patient or client should proceed when entering into any therapuetic situation or relationship. Keeping in mind that there are theories that may or may not apply and that in fact, one may come up with a different scenario or interpretation of their past that has not been recorded or seen with significance by anyone exept them. It is important to (as best one can) be true to their own story – it may uncover new insight to the whole human drama but most importantly it is meaningful to the individual. My advice- don’t follow tha path of others too closely – that includes your shrink.

Ann

Dr. Throckmorton and Mark,

Can you PLEASE contribute more on the blog? Your comments are invaluable.

ken

Warren said in post 80405:

If it makes it clearer, if a kid said I am attracted to the same-sex and I have always been attracted to the same-sex with no opposite sex attraction, I would label such a kid confused or in some stage.

No, I don’t find this very clear at all. Why would you label a kid who says he’s never had opposite sex attraction as “confused”?

http://www.wthrockmorton.com Warren

sigh – Would not label such a kid…

http://www.sexualidentityinstitute.org Mark

When I’ve worked with adolescents who report stable, exclusive SSA, I tend to reflect on various models of sexual identity development. There are many (e.g., Cass, Troiden, McDonald, etc.). These models have been criticized for a number of reasons (e.g., assumptions about homogeneity of experience, linear, etc.), but they have been generally helpful to me. My own experience and research in this area has suggested that there may be a time when an adolescent makes an initial attribution (about what SSA means to them or signals about them), so I consider whether this is what the young person is expressing. That initial attribution may change or expand to include other considerations, and in my experience it may not be consolidated until years later – sometimes into the mid twenties (for a small sample of gay Christians we studied) and into the early thirties (for a small sample of ex-gay Christians we studied). These are considered milestone events in the consolidation of a sexual identity and include attractions, behavior, first relationship, labeling, etc.